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FORM - STC - 104
r
AS BUILT SANITARY SYSTEM REPORT
OWNER TOWNSHIP
SECTION -3 0 T 31 N-R CB W
ADDRESS Z e) 0,., , - ST. CROIX COUNTY, WISCONSIN
SUBDIVISION LOTe2 LOT SIZE Z-z
PLAN VIEW k,07- / C SI;j 02V 5 11 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
~F
96
INDICATE NORTH ARROW
BENCHMARK: Elevation and description: / ~QQ r
Alternate benchmark
SEPTIC TANK: Manufacturer: . Liquid Cap.
II~ 69'
Manhole cover elev:Final grade elev:
Rings used:
0
Tank inlet elev.: Tank outlet elev.:
No. of feet from nearest road:Front;7 Z~,'Side , Rear Ft.
From nearest prop. line: Front , Side, Rear Ft.
No. of feet from: Well yr Building: /
(Include this information in the above plot plan)
(2 reference dimensions to septic tank)
SEE REVERSE SIDE
I
PUMP CHAMBER
Manufacturer: ~Manuf quid Capacity:
Pump Model: Pump/Sip n a Pump Size
Elevation of inlet: Bottom of tank elevation
Pump on elev.: ump off elev.: Gallons/cycle:
Alarm: Man.: Switch Type: Location
Distance fr nearest prop. line: Front-, Side, Rear_Ft.
Dis from: Well Building
SOIL ABSORPTION SYSTEM
Bed: Trench: Seepage Pit:
i
Width: Length /,ja Number of Lines: / Area Built ~4C7
Exist. Grade Elev. Proposed Final Grade Elev.
Fill depth to top of pipe: -Z 0-1
i
No. feet from nearest prop. line:Front , Side, Rear Ft.
No. feet from well:----No. feet from building J?
HOLDING TANK
Manufacturer: Capacity:
No. of rings used: levation of bottom tank:
Elevation of inle .
No. feet from earest prop. line:Front , Side , Rear Ft.
No. feet f m: Well building , nearest road
Alarm M ufacturer:
INSPECTOR
DATE: pl> PLUMBER ON JOB*
LICENSE NUMBER:
TT
6/90:cj
DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING
LABOR &i-IUMAN RELATIONS DIVISION
P.O. BOX 7969 ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
MADISON WI 53707 S ate Plan I.D. SE 4 , SE~ , Sec. 30, T31-R18 (Ifasigned) Number:
Town of Star Prair]~e-, ❑ CONVENTIONAL ❑ ALTERATIVE
I-I Holding Tank ❑ In-Ground Pressure ❑ Mound
R NAME O ERMIT OLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE:
-gL/
BEN H MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.:
Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number:
SEPTIC TANK/HOLDING TANK:
MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
J 1, JD o ' ' ` ❑ YES ❑ NO ❑ YES NO
BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH
ALARM: FEET FROM LINE: AIR INLET:
❑YES ENO ❑YES 21 NO NEAREST-41- dot
DOSING CHAMBER:
MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER
PROVIDED: PROVIDED:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
GALLONS PER CYCLE: P A MTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
I ~ ~ ~AAP
(DIFFERENCE BETWEEN FEET FROM LINE AIR INLET:
YES ❑ NO NEAREST
PUMP ON AND OFF
SOIL ABSORPTION SYSTEM. Check the soil mQi to e t t e depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING:
or excavation. (If soil can be rolled into a wire, co tructi n shall cease until MAIN
the soil is dry enough to continue.)
CONVENTIONAL SYSTEM:
WIDTH: LENGTH:
BED/TRENCH NO.OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID
TRENCHES: MATERIAL: PIT DEPTH:
DIMENSIONS v
GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH
BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET;
.1 _
'2 l NEAREST----* ~
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS;
❑ YES ❑ NO ❑ YES ❑ NO
DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED:
CENTER: EDGES:
❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM:
BED/TRENCH WIDTH: LENGTH: NO.OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER:
TRENCHES:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING:
ELEV.: ELEV.: DIA.: ELEV.: PIPES: DIA.:
ELEVATION AND
DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO
INFORMATION APPROVED PLANS
❑ YES ❑ NO ❑ YES ❑ NO
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: 71LDIN
COMMENTS: FEET FROM LINE
❑ YES ❑ NO ❑ YES ❑ NO NEAREST-
System on Retain in county file for audit.
Sketch t
Reverse Side. SIGNATURE: TITLE:
SBD-6710 (R. 06/88)
ILHR SANITARY PERMIT APPLICATION
In accord with ILHR 83.05, Wis. Adm. Code COUNTY
St. Croix
.
IE~
STATE SANITARY PERMIT #
-Attach complete plans (to the county copy only) for the system, on paper not less than El /,!J 7
8fz x 11 inches in size. c ec revision co re iousapplication
-See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION.
PROPERTY OWNER PROPERTY LOCATION
Ronald L. Derrick SE '/4 SE '/4, S 30 T 31 , N, R 18 E (or) W
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK #
520 Pine Ridge Dt. n/a n/a
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME ORJQSM NUMBER
New Richmond, Wi. 54017 715- 462320 n/a 501
II. TYPE OF BUILDING: (Check one) 1:1 State Owned 0 CI TTY LLAGE: N EST AD
r7a.Tow OF: Star Prarie
❑ Public ia1 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX NUMBER(S)
III. BUILDING USE: (If building type is public, check all that apply) t 5-1q G-
1 ❑ Apt/Condo
2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility
30 Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining
4 ❑ Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash
50 Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify
IV. TYPPEII OF PERMIT: (Check only one in line A. Check line B if applicable)
A) 1.1E 1 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5.0 Repair of an
System System Tank Only Existing System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non-Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 ❑ Mound 300 Specify Type 41 ❑ Holding Tank
12 Seepage Trench 220 In-Ground 42 ❑ Pit Privy
13 ❑ Seepage Pit Pressure 43M Vault Privy
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION
450 500 500 .90 <3 96.94 Feet 100.58 Feet
VII. TANK CAPACITY Site
in allons Total # of Prefab. Fiber- Exper.
INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App
Tanks Tanks structed
Se tic Tank or Holdin Tank
Lift Pump Tank/Si hon Chamber
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installatio f the onsite sewage system shown on the attached plans.
Plumber's Name (Print): Plumber's Sig Ore: (No S ) WMPRSW No.: Business Phone Number:
Gary L. Steel 3254 715 4606200
Plumber's Address (Street, City, State, Zip C
1554 200th. Ave. New Richmond Wi. 4017
IX. COUNTY/DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signature (No Stamps)
LKp'proved ❑ Owner Given Initial ~_-Surcharge Fee) '
Adverse Det rmin tion
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-8398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to county, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable. ,
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
11. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards,
sBD-6398 (R.11/88)
APPLICATION FOR SANITARY PERMIT
STC - 100
This application form is to be completed in full and signed by the owner(s) of the
property being developed. Any inadequacies will only result in delays of the permit
issuance. Should this development be intended for resale by owner/contractor, ("spec
house"), then a second form should be retained and completed when the property is
sold and submitted to this office with the appropriate deed recording.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Owner of Property ~OI~~CVD b~-r
Location of Property h;, Section , TN-RIC:D W
Township '5~AA, PV~V~6
Nailing Address
F1 Ui
NtA.Aj
Address of Site
0,0 J'
Subdivision Name C~eV--T) Fl 9-,P j y12,-V9-'f
Lot Number yy
Previous Owner of Property A A 1L~1l~l~~orJ ~i r:!~bNo to FjAkL ukr eov\
Total 81me of Parcel
Date Parcel vas Created
Are all corners and lot lines identifiable? Yes No
Is this proprpe y being developed for resale (spec house) ? Yes _ No
Volu>re and Page Number ~s recorded with the Register of Deeds..
INCLUDE WITH THIS APPLICATION THE FOLLOWING:
A Warranty Deed which includes a Document number, volume and page number, and the
Seal of the Register of Deeds. In addition, a certified survey, if available, would be
helpful so as to avoid delays of the reviewing process. If the deed description refer-
ences to a Certified Survey Map, the Certified Survey Map shall also be required.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
PROPERTY OWNER CERTIFICATION
1 1190 cvktk6y that att btatemeltu oil VuA 6onm ane tptue to the beAt 06 my (oun)
hnc o dge_; that 1 (wel am (aArl the owtteh(b 06 the pnopehty de r-Ai.bed in thin
.inO!1ma.LLon 6optm, by viVue 06 a waAAanty deed heconded in .the 066tce 06 the
Countyy RegiAt" o6 Deerijah Document No. 579 y-A ; and .that I (We) pne~senLCy
c.vn tJie pnopoded a i,te bon tite -setuage d.iAPOA Ayh e-m (oh I (we) have obtained an
o_aAf-mCnt, to hun w.i,th the above deAchibed ptopeAty, 6oh the eonAthuc-Uon 06 Adtd
system, and .the Acme has been duty heconded .tn the 0661ce 06 the Cowtty RegizteA 06
Peedd, Poe ment No ) .
SIGNATURE Olt OWNER SICttATURE OF CO-OWNER (IF APPLICABLE)
8-ag;4~ D
DAT^ "IGNED DATE SIGNED
DOCUMENT. NO. WARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA
ASTATE BAR OF WISCONSIN FORM 2 - 1982
. ' '3~J r
REGISTER'S OFFICE
ST. CROIX W-* WI
Reed for R®cerd
Gary H Bai 1 1 argeon and Bonnie F. Bai 1 1 arge n APR2 5 WO
husband and wi fe at 2:45 P. M
conveys and warrants to R o n a l d L D e r r i c k
• Regtste~ of beads
RETURN TO
Century 21
Somerset, Wi. ~
the following described real estate in St- Croix County,
State of Wisconsin:
Tax Parcel No:
Part of the South I of the Southeast a of Section 30,
Township 31 North, Range 18 West, St. Croix County,
Wisconsin described as follows: Lot 1 of Certified Survey
Map filed October 31, 1977 in Volume "211, Page 501,
Document #344235.
Together with the private street/private road/private drive
as shown on Certified Survey Map in Volume "2", page 354,
Document x/339084; Volume "2", page 500, Document #344234;
Volume "2", page 502, Document x/344236 and in Volume "2",
page 501, Document #344235.
This i s not homestead property.
(is) (is not)
Exception to warranties: recorded easements and rights of way.
Dated this 25 day of April 1 19 9 0
$uG ~J c•~~c1 L"~~cSCr r (SEAL)
9:- ~ ~ (SEAL)
Gary H. Baillargeon Bonnie F. Baillargeon
*
(SEAL) (SEAL)
*
*
AUTHENTICATION ACKNOWLEDGEMENT
Signature(s) STATE OF WISCONSIN
ss.
S G Croix County.
Personally came before me this 25 day of
authenticated this day of , 19 April 119 -the above named
Gary"h Baillargeon and
F Rai 11 ar~Pnn
Bonnie
TITLE: MEMBER STATE BAR OF WISCONSIN'
(it not, to me knoq °f xe persons who executed the
authorized by § 706.06, Wis. Stats.) foregoi ment and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
John D. Walsh
tary "Public a County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is per anent. (If not, state expiration
are not necessary.) date: 4 _9 Z- 19 )
*Names of persons signing in any capacity should be typed or printed below their signatures.
WARRANTY DEED STATE BAR OF WISCONSIN 1Ha es Road, Madison, W sconnsin 53 04
FORM No. 2 - 1982 4801 y
'J.
r
SEPTIC TANK MAINTENANCE AGREEMENT
St. Croix County
OWNER/BUYER ' N ~+r~~•'L~-~~
ROUTE/BOY NUMBER =7 ~J ►~~iCa Fire Number 4
CITY/STATE ZIP
i'
Pr?OPERTY LOCATION: le Section, T3/ N, R ~ ~W, j
Town of StIA St. Croix County,
A I
Subdivision Lot number '
~I
I
Improper use 9nd maintenance of your septic system could result in ~I
its premature failure to handle wastes. Proper maintenance con- I'
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the Eunction of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration.
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with
the standards set forth, herein, as set by the Wisconsin Depart-
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning Office within 0 days
of the three year expiration date.
SIGNED 2A~~'t l
DATE
St. Croix County Zoning Office
P.O. Box 227
Hammond, .JI 54015
715-196-2239
Si.<<n, daro and rernr.n r.o ;above address.
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
~IfdDUSTRY, DIVISION
P.O. BOX 76
LABORAND PERCOLATION TESTS (115) MADISON WI 3707
HUMAN RELATIONS
(ILHR 83.0911) & Chapter 145)
LOCA1 ION: SECTION: TOWNSHIP/M~: LOT N
SE Se ' 30 T31 H RL8x O.: BLK. NO.: SUBDIVISION NAME:
E (or) W Star Prarie n /a a n
n
COUNTY: BUYER'S NAME: MAILING ADDRESS:
Croix Ronald Derrick 520 Pine Ride Crt. New Richmond, Wi. 54017
USE DATES OBSERVATIONS MADE
I NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROF LE DES IPT ONS: 1PERCOLATION TESTS:
~esidence X~ New ❑ Replace
3 n /a Rn-An-90 /
RATING: S= Site suitable for system U= Site unsuitable for system
ONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional)
®;S ❑ U ®S ❑ U [ S U ❑ S ®U El S ix] U conventional
If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s. ILHR 83.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a
decimal' PROFILE DESCRIPTIONS
BORING TOTAL D PTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B-1 17.41 99.72 none >7.41 .58bl.1. 1.83bn.s.1. .83bn.c.s.&gr. 4.17bn.c.s.
B-2 16.92 99.93 none >6.92 .75bl.1. 1.67bn.s.l. 4.50bn.c.s.
B-3 6.91 99.62 none >6.91 .75bl.1. 1.33bn.s.l. 2.00bn.l.s.&gr. 2.83bn.c.s.
B-
B this is
B-
PERCOLATION TESTS
TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER INCHES AFTER SWELLING INTERVAL-MIN. PERIOD 1 PERIOD 2 PERI PER INCH
P-
P-
P_ see eSl rate
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope.
SYSTEM ELEVATION 96.12
,
I
,
3
€
O
3 rA"~J
.0
,
82 e
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
8030-90
ADDRESS: CERTIFICATION NUMBER: HONE NUMBER (optional):
1554 200th Ave., New Richmond, Wi. 54017 2298 V15,-24F-6200
CST SIGNAT
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 10/83) - OVER -
w,
r.;
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DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
'LABOR AND PERCOLATION TESTS (115) P.O. BOX 7969
HUMAM RELATIONS 1 / MADISON, WI 53707
(H63.090) & Chapter 145.045)
LOCATION: SECTION: TOWNSHIP/MUNICIPALITY: LOT NO.:BLK. NO.: SUBDIVISION NAME:
SE • '/4SE/4 30 /T 31 N/R18)Lor) W Star Prarie
COUNTY: OWNER'S BUYER'S NAME: MAILING ADDRESS:
St. Croix David Bracht 1311 Sara Ln. Somerset Wi. 54025
USE DATES OBSERVATIONS MADE
t NO. BEDRMS.: COMMERCIAL DES RIPTION: I R F IPTIONS: LATION TESTS
: :a DESCR79-0
4r,
[:,icl,nce 3 n/a New ❑Replace It 8-11-8$ 8-11-88
RATING: S= Site suitable for system U= Site unsuitable for system
rONVENTIONAL: MOUND: jff-GROUNI)-PRESSURg:ISYSTEM-IN-FILOLDING TANK: RECOMMENDED SYSTEM: (optional)
❑U E S ❑ U oS ❑U ❑ S &UL H❑ S kU conventional
if Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the
under s.H63.09(5)(b), indicate: n/a I Floodplain, indicate Floodplain elevation: n/a
decimal' PROFILE DESCRIPTIONS page 19 BrB
BORING TOTAL JELEVATION DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH
NUMBER DEPTH OBSERVED E HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.)
1 i 6.83 100.04 none >6.83 1`.00bl.s.l. .83bn.s.l. 5.00bri.c.s.&gr.
B_ 2 7.09 99.94 none >7.09 .75bls.l. 1.42 bn.s.l. 1.25bn.c.s.&gr. 3.67bn.c.s
g_ 3 6;67 100.58 none >6.92 .67bl.s.l.A .00bn.s.l. 2.50bn.c.s.>. 2.50bn.c.s
B- 4 6.84 101.04 none, >6..84 1.00bl.l.',1.00bn.s.l. 2.17bri.c.s.&gr. 2.67bn.cc.s
D- 5 6.64 99.94 none >6.64 .58bl.s.i. .67bn.s.1. 2.50bn.c.s.&gr. 2.89bn.c.s.
B-
decimal' PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TESTTIME DROP IN WATER LEVEL-INCHES RATE MINUTES
NUMBER XNKKESCC AFTER SWELLING INTERVAL-MIN. PERI D ERI-a 1-111003 D PER INCH
P- 3
P-2 3.00 none 3 6 6 6 <3'
P-3 3.64 none 3 6 6 6 <3~Fpl
-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope- -
SYSTEM ELEVATION 96.94
Ts '
1 - -
-1 V10
k4 5
I
J_> r
m i
( 1
_iv
I NJ
or i
I
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i
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i
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I
f_
~ 3 srw ).a+
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rr-
(L\JV`~Y~~~
1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief.
NAME (print): TESTS WERE COMPLETED ON:
Gary L. Steel 8-11-88
ADDRESS: CERTIFICATION NUMBER: JPHONE NUMBER (optional):
988 N. Shore Dr., New Richmond, Wi. 54017 22 8 715g46-6200
CST SIG E:
DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester.
DILHR-SBD-6395 (R. 02/82) -OVER -
ti .
STEEL'S SOIL SERVICE t554 200M. AVe.
Gary L. Steel :QQHbbSdwmcp&e
C.S.T. 2298 New Richmond, WI 54017
MPRSW-3254 (715) 246-6200
Ronald L. Derrick
SE4SEh S.30 T31N R18W
voStar Prarie, township
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T
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s ' 5e, 94'0
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120
344235 _y
Part of the South 1/2 of the Southeast One Quarter (SEj) of Section Thirty (30), Township
Thirty-one (31) North, Range Eighteen (18) West, Town of Star Prairie, St. Croix County,
Wisconsin described in Volume 2 of Certified Survey Maps on Page 501 as
Certified Survey No. 501
ST CRO/X COUNTY CERr/F/ED SURVEY NOL.5ol
t EO
c ~ OCT 3Y ~
I, APPROVED in A4ft O,ro 977
f1GrM of 0• Rz
ods
1!✓ s ii^
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,
O CT 19 1977 tr.
ST. CROIX COUNTY Z
COMPREHENSIVE PARKS PLANNING
AND ZONING COMMITTEE
A' I't"L'VAl. i' li•:.• f'r1.i'i i. JV.: L. Vi.;i~.IV
00rS I M-AN APPi:CVAL FOR
BUILDING Sift OR SEPTIC SY;TEM,,
REFER TO H62.20.
BEARINGS REF TO THE EAST LINE
OF THE SE 1/4 - SEC. 30, T31N,R18W
ASSUMED BRG. N 00° 23'50°E.
SCALE IN FEET
100 0100
0 -1° X 24° IRON ROD WEIGHING o ° 1260 33'42"
2.67 LBS/L.F. R = 80.00'
•-1-1/4°X30° IRON PIPE L = 176.71'
L.C. = 142.92
UNPLATTED CHORD BRG.-S 09°43' 13°E
......LA/V03
A 3760 3g' 27" _
QQ Ap 59.07 S 890 4d 25''E 1 T \
/ Q' ODj,L~h ° 156.90 $ \
LOr s ~0 _
42, 154047'00"
NIw 1
77028'58" 1. 45 AC.
N W- ,
N 760 84.22'
a 39,2711 w o r 1670
14.98' 198.50 93°03 qp
,
N 250 51 35 E N 890 49 25 W 9.22
P.0.8. I I S 03° 14'15~~W
I 38 ~ 38~
UNPLATTED ~
rj Fi
LANDS I
O'c~o~ui~~' I
v °
z
VIL N z
t ° try
4
7.y W ! ~0w~ _ N 89049'25"W 838.09
'~+''Y,O~''••• ..•••!'~•~j SOUTH LINE SE 1/4
~r~P1,f fStU SE. COR.-SEC. 30
T 31 N, RIBW
00
Volume 2 Page 501 Sheet 1 of 2 sheets